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Lupusnephritis

Lupusnephritis

  • CME Weiterbildung · Zertifizierte Fortbildung
  • Published:
Der Nephrologe Aims and scope

Zusammenfassung

Bei einem systemischen Lupus erythematodes muss bei 30–90% der Patienten im Verlauf mit einer renalen Beteiligung gerechnet werden. Diese ist entscheidend für die Morbidität und die Mortalität der Patienten verantwortlich. Die Lupusnephritis wird nach der Histologie in 6 Klassen eingeteilt, wobei die Klinik keine Vorhersage der Klasse erlaubt. Daher ist eine Nierenbiopsie unumgänglich, da sich die Therapie nach der Klasse richtet. Während bei der mesangioproliferativen Lupusnephritis (Klasse II) meist die extrarenalen Manifestationen die Therapie bestimmen, kommt man bei einer proliferativen Lupusnephritis (Klasse III fokal, Klasse IV diffus) nicht um eine Immunsuppression mit Cyclophosphamid, in letzter Zeit häufiger alternativ Mycophenolat-Mofetil (MMF), nicht herum. Bei der membranösen Glomerulonephritis (Klasse V) steht die Blockade des Renin-Angiotensin-Aldosteron (RAAS)-Systems ganz im Vordergrund. Klasse I (minimale mesangiale Lupusnephritis) und Klasse VI (Sklerose) bedürfen keiner immunsuppressiven Therapie. Neuere Therapieoptionen betreffen die B-Zell-Depletion, die Hemmung von Zytokinen oder ko-stimulatorischer Moleküle und kürzlich die Inhibition des B-Lymphozyten-stimulierenden Faktors (BLyS), wobei nun erstmals ein monoklonaler Antikörper (Belimumab) beim SLE in Kombination mit der Standardtherapie zugelassen ist.

Abstract

During the course of systemic lupus erythematosus (SLE) 30–90% of patients develop a renal manifestation which has proven to be decisive for morbidity and mortality. Histologically six different classes have been described leading to different treatment strategies. In mesangial proliferative lupus nephritis (class II) extrarenal manifestations determine the immunosuppressive treatment. However, in class III and IV (focal or diffuse proliferative manifestation) cyclophosphamide or possibly mycophenolate mofetil (MMF) as an alternative is necessary. In membranous lupus nephritis (class V) dual renin-angiotensin aldosterone (RAAS) blockade is most important. With class I (minimal mesangial lupus nephritis) and class VI (sclerosis) no immunosuppressive therapy is needed. New treatment options concentrate on B-cell depletion, inhibition of cytokines and co-stimulatory molecules. Recently, for the first time in SLE, a monoclonal antibody (belimumab) against B lymphocyte-stimulating factor (Blys) has been approved for treatment in combination with standard therapy.

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Danksagung

Die Abbildungen 1 und 2 wurden freundlicherweise von Dr. J.U. Becker, Institut für Pathologie der Medizinischen Hochschule Hannover, zur Verfügung gestellt.

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Vortragshonorare von Roche und Aspreva.

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  1. Medizinische Klinik III, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Deutschland

    M. Haubitz

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Haubitz, M. Lupusnephritis. Nephrologe 7, 63–74 (2012). https://doi.org/10.1007/s11560-011-0613-8

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